COVID-19 pandemic reduced number of people using health services after self-harming, systematic review suggests

The number of people presenting to health services after self-harming reduced during the COVID-19 pandemic in many high-income countries, according to a systematic review of 51 studies carried out by researchers at the NIHR Applied Research Collaboration West (ARC West), the NIHR Bristol Biomedical Research Centre (Bristol BRC), the University of Manchester, NIHR Greater Manchester Patient Safety Translational Research Centre and Swansea University. Most of the reviewed studies reported either no change or falls in the number of people using health services following self-harm between 1 January 2020 and 7 September 2021.

Other research has shown that the COVID-19 pandemic took a toll on the mental health of the population and put a strain on health systems. It increased risk factors for suicidal behaviour, such as job insecurity and unemployment. It also reduced access to food, education, healthcare and limited the availability of support from family and community.

Despite the overall increase in the number of stress factors, the research team found that fewer people were presenting to hospitals following self-harm. It’s possible that this reflects changes in the threshold for when people chose to seek help. It’s also possible that people were using alternative sources of support and it might also reflect the variable effects of the pandemic across different social groups.

Some of the reviewed studies included months from 2021 in the observation period. Thanks to this, researchers were able to establish that the number of people seeking mental health support after self-harm in 2021 was either closer to, although lower than, pre-pandemic levels, or in line with expected numbers. Data from 2021, however, also suggested that more teenage girls were using health services after self-harm. The quality of the reviewed studies was not the same and researchers divided them into three tiers (low, moderate and high-moderate).

None of the studies reporting an increase in the number of people seeking help for their mental health were labelled as being of high-moderate quality, while all the studies rated high-moderate reported a reduction in the number of people seeking help.

David Gunnell, Professor of Epidemiology at the University of Bristol, said:

“These results have added to the growing body of evidence in our living systematic review of the impact of COVID-19 on self-harm and suicidal behaviour.

“The apparent fall in hospital presentations for self-harm is consistent with other evidence showing that in many countries suicide rates fell during the early months of the pandemic. These falls are in marked contrast with the increased levels of distress possibly reflecting increased levels of social cohesion during the early months of the pandemic.”

Emily Eyles, Research Associate, said:

“Our review highlighted a paradox at the start of the pandemic: life was becoming more stressful but, on the face of it, fewer people were using health services to get help for their mental health. It is important for us to understand why this happened and whether it has had a long-term impact on the number of people getting help when they are struggling with their mental health.”